Obesity is a major health problem in the U.S. particularly in individuals with severe mental illness. Not only is the prevalence of obesity higher in the severely mentally ill, the mortality rate in persons with schizophrenia is 2-3 times higher compared to the general population. This drastically higher mortality rate continues to increase and appears to be related to medical conditions associated with obesity. Side effects from new medications for schizophrenia may induce further weight gain and the resulting medical morbidity and mortality. Other factors such as sedentary lifestyle, limited healthy food options for poverty stricken patients, as well as inadequate knowledge and understanding of health maintenance, appear to contribute to increased obesity rates in the schizophrenia population. New methods are urgently needed to tackle this growing problem of obesity and the related morbidity and mortality. Studies have shown that behavioral interventions promoting lifestyle changes are successful in reducing health risk behaviors at both a clinical and community level in non-psychiatric populations. A similar approach, with appropriate modifications, may be the key to tackle the obesity epidemic in vulnerable populations such as the severely mentally ill. Based on this premise, we conducted a randomized controlled pilot trial with 18 obese subjects with schizophrenia using a behavioral intervention consisting of: a multifaceted nutrition intervention, a food provision program, health education, and encouragement to increase physical activity. The behavioral intervention was based on an intervention widely used in the general population that we modified for patients with probable cognitive deficits and lower than average knowledge about nutrition, shopping, and cooking. In addition, we added a novel food provision program with shopping instruction and personalized food selections. This intervention led to significantly greater weight loss in the intervention group compared to control subjects. Furthermore, weight loss continued over six months after the intervention ended. In this R01 application, we are requesting support for a clinical trial that would test the effectiveness of our program in a much larger sample not only for weight loss, but also in terms of reduction of risk factors and markers for obesity related morbidity as well as increased quality of life. Obesity and obesity related medical conditions contribute to increased mortality among persons with schizophrenia and increased healthcare costs. There are no treatments that have been convincingly shown to be effective for weight reduction in this population with unique needs. We aim to test a weight management program we have developed specifically for this population which was found to be effective in arresting weight gain, producing durable weight loss and improving metabolic markers among severely mentally ill patients in preliminary studies.